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<meta name="description" content="这是口腔外科常用器械材料的最后一部分啦。同样还是读书笔记。缝线（Sutures）自从1865年消毒和灭菌技术应用到外科手术以来，缝合技术有了很大的发展。缝线有两种基本类型：可吸收和不可吸收的。可吸收缝线（Resorbable Sutres）：在一定的时间以后会吸收，通常与创口愈合的时间相一致。这些缝线常用一些动物的内脏组织等制成（如肠线catgut，胶原等），或者用合成材料（如多聚酸(polygl">
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          <h1 class="post-title" itemprop="name headline">口外常用器械（补遗）</h1>
        

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        <p>这是口腔外科常用器械材料的最后一部分啦。同样还是读书笔记。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/01.jpg"><br>缝线（Sutures）<br>自从1865年消毒和灭菌技术应用到外科手术以来，缝合技术有了很大的发展。<br>缝线有两种基本类型：可吸收和不可吸收的。<br>可吸收缝线（Resorbable Sutres）：在一定的时间以后会吸收，通常与创口愈合的时间相一致。这些缝线常用一些动物的内脏组织等制成（如肠线catgut，胶原等），或者用合成材料（如多聚酸(polyglcolic acid, Dexon））。肠线常在术后8天吸收，胶体缝线(chromic sutures）12-15天吸收，合成材料的缝线(synthetic, Dexon)约30天吸收。这些缝线用于张力较小的瓣，儿童，精神障碍患者，通常用于无法复诊拆线的患者。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/02.jpg"><br>不可吸收缝线（Nonresorbable Sutures)<br>必须在术后约7天拆线。由各种天然材料制成，主要是外科丝线（surgical silk）以及外科棉线(surgical cotton suture）。丝线是最易使用并且最经济的，有理想的缝合效果。<br>最常使用的缝线，对于可吸收缝线直径是4-0和3-0的，对于不可吸收缝线直径是3-0和2-0。(不可吸收缝线用的要更细）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/03.jpg"><br>缝针(Needles）<br>有各种型号，形状，直径的缝针可供选择。常用不锈钢制成。外科常用的针是防止损伤的一次性使用的缝针（atraumatic disposable needles）。<br>圆形或卵圆形横断面的缝针（Needles with Round or Oval Cross-Sectional View)<br>被认为对组织损伤较小，主要用于缝合较薄的粘膜。其缺点是穿过组织时需要较大的压力，可能会使缝合创缘更加困难。<br>三角形针（Triangular Needles）<br>有锐利的切割边缘，用来缝合较厚的组织。当用他们来缝合薄的粘膜时，必须小心，因为它们可能会撕裂组织。最适合的缝针是半圆形或3/8圆的针（指针的长度，不是横截面形状），长度为19-20mm。<br>（总结：圆针或卵圆针对组织损伤小，但难穿。三角针反之。）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/04.jpg"><br>局部止血剂(Local Hemostatic Drugs)<br>仅供局部使用，应用于毛细血管或小动脉损伤造成的大量出血。<br>海藻酸盐(Alginic Acid)：5mg瓶装的粉末形式出售。置于出血的表面，形成一个保护膜，对毛细血管形成压迫并帮助血凝块固定。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/05.jpg"><br>天然明胶海绵（Natural Collagen Sponge）：是白色的海绵材料，不产生抗原抗体反应(nonantigenic），完全可吸收。其止血功能主要靠提高血小板集聚能力。它还能激活凝血因子ⅩⅠ和ⅩⅢ，主要用于牙科外科手术后大出血的患者。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/06.jpg"><br>纤维蛋白海绵（Fibrin Sponge）：从牛材料上制取并经过处理，不会产生抗原抗体反应。局部应用，尤其是拔牙后拔牙创的出血。它能促进血凝，形成正常血凝块。但在出血区域以外，它同样有填塞的功能。它能在4-6周内完全吸收。<br>明胶海绵（Gelatin Sponge）：类似海绵类的材料，无抗原抗体反应，完全可吸收。使用与纤维蛋白海绵类似。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/07.jpg"><br>氧化纤维素(Oxidized Cellulose）：可吸收的止血材料，用经过氮氧化物氧化的细胞纤维素制成。有膜状的和球状的。它能释放酸性细胞毒素(cytotoxic acid），对血红素（hemoglobin）有吸引作用。它形成的网状结构适合于拔牙后牙槽窝出血。它被认为比其它止血海绵要高级，所以应用越来越多。(Its attachment to the walls of the postextraction socket for the treatment of bleeding is quite satisfactory and therefore it is considered superior to various other hemostatic sponges, which have a tendency to expel thematerial from the socket.)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/08.jpg"><br>骨蜡(bone wax):是被灭菌的，不可吸收的蜡状混合物。由白色蜂蜡，石蜡等成分组成。它是白色的，2.5g重的白色固体方块。用来控制来源于骨或骨缺口边缘的出血。其止血机制是穿过含有出血的血管的骨空腔。<br>(止血剂还是必要的，我在这几年拔牙过程中碰上过几例拔牙后出血多的，还好貌似都是毛细血管出血那种渗血，而不是动脉出血。备点止血剂还是必要的。)<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/09.jpg"><br>覆盖或填塞手术创面的材料<br>凡士林纱布（Petrolatum Gauze，Vaseline）：用来填塞颌骨囊肿手术后的空腔，以及上颌静脉窦(maxillary sinus)等。在使用前必须把纱布上多余的凡士林去掉，如果需要，可以使用抗生素软膏（四环素类）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/10.jpg"><br>碘仿纱布(Iodoform Gauze）：具有防腐，镇痛，止血的功能。使用的指征和凡士林纱布相同，但它可以在体内待更长的时间。也有小袋的包装，用于干槽症（dry socket）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/11.jpg"><br>外科敷料(Surgical Dressing）：常温聚合的膏状物，无菌包装。用于牙周手术或口腔手术，作为术后覆盖创口的临时性保护材料。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/12.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/13.jpg"><br>组织再生材料(Materials for Tissus Regeneration）<br>有时在术后会形成一些大的骨的缺损，会带来美学，功能和愈合过程的问题，甚至会影响到颌骨的稳定性。近来有很多材料应用到口腔外科，用来辅助骨缺损区域的骨再生，消除骨缺损或限制其大小。这些材料也有助于牙周组织的再生。比如用来填塞种植体周围的缺损，或者用在缺损的牙槽嵴周围。最常用的材料是膜和骨移植物(membranes and bone grafts）。<br>生物膜：有可吸收的和不可吸收的。人工合成的胶原聚合物膜是可吸收的。不可吸收的膜包括钛增强的膜，钛网膜等。不可吸收膜的缺点是必须进行二期手术取出。<br>骨移植物<br>分四类：①同种移植物，从患者自己体内取得的骨组织；②同种移植物，从其它人体内取得的骨组织；③异种移植物，从其它动物体内取得的骨组织。④异质移植物(Alloplastic grafts），人工合成的骨替代物，如羟磷灰石（hydroxylapatite），含钙磷的生物陶瓷(phosphoric calcium ceramics），以及乳状的氢氧化钙（oily calcium hydroxide in cream form）。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/14.jpg"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0010-kwcyqxby/15.jpg"><br>其它一些材料含有牙釉质蛋白(amelogenin，是牙釉质中的一种蛋白成分),也可以促进组织再生。<br>自体骨移植在所有材料中能取得最好的效果。但它的应用受限，因为需要在取骨的地方再进行一个手术。所以临床中人工合成的材料用的比较多。<br>(器械和材料总结完了，接下来就该到拔牙了。)</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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